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- Title
Barriers to Healthcare in a Multiethnic Cohort of Systemic Lupus Erythematosus (SLE) Patients: Patient and Physician Perceptions.
- Authors
Law, Genevieve; Pope, Janet; Lalani, Sheliza; Silverman, Earl; Cooper, Glinda; Fortin, Paul; Zummer, Michel; Smith, C. Douglas; Petty, Ross; Tucker, Lori; Albert, Lori; Huber, Adam; Ramsey, Susanne; Arbillaga, Hector; Chedéville, Gaëlle; Hudson, Marie; Peschken, Christine
- Abstract
Objective: Barriers to medical care may influence health status. It is unclear whether problems with access can predict clinical outcomes in lupus. This study aimed to determine whether care barriers are associated with increased disease activity and damage in a multi-center, multiethnic SLE cohort. We also compared concordance between care barriers as reported by the patient and lupus specialist. Methods: Data from SLE patients in 12 Canadian centers collected at annual visits, including demographics, treatment, disease activity and damage were analyzed. Results: 654 patients were enrolled with ethnic groups being Caucasian [CC] (64%), Aboriginal [ABO] (9%), Asian [AS] (21%), and Black [BLK] (6%). 50.8% had at least one barrier to care including travel to a rheumatologist (32.0%), waiting to see a rheumatologist and cost of medications. Access to medication and costs were signifi cantly associated with co-morbidity (p < 0.001, p = 0.04). There were signifi cant associations between ethnicity and any physician perceived care barrier (p < 0.001), mostly in Aboriginal. Doctors identifi ed half of patients who had access to medication problems (p = 0.003) and the relationship between doctors and patients identifying similar care barriers was weak (r = 0.09). A lower total household income signifi cantly predicted the presence of any care barrier (p < 0.001). Conclusions: Despite access to a lupus specialist many care barriers were identifi ed, although we found few associations between care barriers and patient outcomes. The cost of medication was related to SLE disease activity; however, we cannot determine if this was cause or effect. Care barriers identifi ed by lupus patients are signifi cantly underestimated by physicians.
- Subjects
SYSTEMIC lupus erythematosus; AUTOIMMUNE diseases; MEDICAL care; MEDICAL care costs; RHEUMATOLOGISTS; RHEUMATOLOGY; RHEUMATISM treatment; PHYSICIAN-patient relations; DIAGNOSIS; PHYSIOLOGY
- Publication
Clinical Medicine: Arthritis & Musculoskeletal Disorders, 2009, Vol 2, p1
- ISSN
1178-1149
- Publication type
Article